RESEARCH AND EDUCATION

Effects of nonaldehyde immersion disinfection on the

mechanical properties of flexible denture materials
Alex Leo Sequeira, BDS, MDS,a Aparna I. Narayan, BDS, MDS,b and Vinu Thomas George, BDS, MDSc

The disinfection of dentures is ABSTRACT

important to avoid infectious
Statement of problem. Variation in the baseline mechanical properties of polyamide thermoplastic
disease transmission. How- polymers used in the fabrication of prosthetic dental appliances and the effects of nonaldehyde
ever, some methods of disin- disinfectants on the mechanical properties of these polymers are unclear.
fection can alter the mechanical
Purpose. The purpose of this in vitro study was to compare the flexural and impact strengths of 2
properties of the denture ma-
flexible denture materials (Valplast and Sunflex) and evaluate the effect of 24-hour immersion in
terials and affect clinical func- nonaldehyde disinfectant (Perform) on their flexural and impact strengths.
tion.1-4 Flexible polyamide
removable partial dentures are Material and methods. Of 48 specimens of Valplast and Sunflex, half were immersed in non-
aldehyde disinfectant solution containing the active ingredient 2% peroxymonosulfate for 24 hours.
an alternative to conventional
Flexural and impact strengths were measured using a universal testing machine. The Student t test
polymethylmethacrylate pros- with Bonferroni correction was used (a=.008).
theses as they can be fabricated
in thinner sections and their Results. For the Valplast group, the mean ±standard deviation flexural strength was 27.8 ±0.57
MPa, and the impact strength was 3.5 ±0.98 kJ/m2. For the Sunflex group, the mean flexural
translucency leads to improved strength was 57.4 ±4.09 MPa, and the impact strength was 6.0 ±3.11 kJ/m2. Sunflex showed greater
esthetics.5 The reduced bulk flexural strength (P.001) and impact strength (P=.001) than Valplast. A significant increase in the
and weight of the prosthesis impact strength (P.001) but not in the flexural strength of Valplast was observed after exposure to
increases patient comfort and the disinfectant solution. Immersion disinfection had no significant effect on the strength of
acceptance of the denture.5 Sunflex.
Flexible polyamide dentures Conclusions. The flexural and impact strengths of Sunflex were significantly greater than those of
are available as monomer-free Valplast. Immersion disinfection with peroxymonosulfate had no significant effect on Sunflex but
products, allowing their use in increased the impact strength of Valplast. (J Prosthet Dent 2019;121:843-7)
patients with hypersensitivity.6
An additional advantage is the flexibility of polyamide Perform (Schülke & Mayr GmbH), a disinfectant
resin denture bases because undercuts are engaged and based on reactive oxygen instead of aldehyde, has also
used to retain the prosthesis.7 been recommended.9 It is supplied in granular form with
As handling dentures after removal from the oral potassium peroxymonosulfate as its active ingredient.
cavity is associated with a risk of infectious organism This aldehyde-free product is claimed to be both biode-
transmission, dentures must be disinfected before de- gradable and effective for reducing Candida levels on
livery or when transferred to a dental laboratory. The flexible dentures.10 Its use in dentistry includes the
British Dental Association Advisory Service recommends disinfection of impressions, as well as of dentures, dental
the use of sodium hypochlorite with 10 000 parts per equipment, and prosthetic materials (https://www.
million (ppm) of available chlorine for the disinfection of schuelke.com/gb-en/products/perform-ID.php). Valplast
prostheses.8 recommends the use of the proprietary denture cleanser

a
Private practice, Axiss Dental, ITPL, Whitefield, Bangalore, Karnataka, India.
b
Associate Professor, Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences, Manipal Academy of Higher Education,
Manipal, India.
c
Associate Dean, Manipal College of Dental Sciences, Department of Prosthodontics and Crown & Bridge, Manipal Academy of Higher Education, Manipal, India.

THE JOURNAL OF PROSTHETIC DENTISTRY 843

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Clinical Implications
A denture made of a polyamide material such as
Valplast is primarily chosen for its inherent ability to
flex and engage undercuts. Disinfection of Valplast
resulted in increased impact strength and hence
rigidity, which could hamper its successful use.
Val-Clean, which contains potassium peroxymonosulfate
as the active ingredient.
Patients are advised to clean their dentures every day
and store them in water when not in use. As long-term
disinfection and water sorption can alter the mechani-
cal and esthetic properties of the denture base,11 the
flexural and impact strengths of flexible denture base
materials and the effect of immersion disinfection in
peroxymonosulfate aqueous solutions on their mechan-
ical properties must be established.
Thermoplastic polymers are produced by the
condensation reaction between a diamine and a dibasic
acid.12,13 The polyamide-based flexible denture materials
retain both elasticity and strength.12-14 The inherent
flexibility of polyamide nylon dentures provides advan-
tages over conventional polymethylmethacrylate pros-
theses,13,15 such as engagement of undercuts where a
conventional denture base would be impossible to insert.
An additional property is the material’s elastic memory,
allowing the prosthesis to revert to its original form after
flexing over an undercut. Similar to conventional clasps,
flexible dentures use elastic memory to engage undercuts
for retention of the prosthesis. Furthermore, the trans-
lucent clasps are more esthetically pleasing than con-
ventional metal clasps.
A denture material’s impact strength is important in
determining its durability16 and ability to absorb energy
during plastic deformation. Both flexural and impact
testing are essential to understand the physical and
mechanical behavior of a material. The effects of im-
mersion disinfection on the mechanical properties of
polymethylmethacrylate have been studied.2,3,17 How-
ever, evaluations of the mechanical properties of poly-
amide denture base materials before and after exposure
to immersion disinfection with potassium perox-
ymonosulfate are limited.18 Some studies have focused
on the effectiveness of disinfection on microbial eradi-
cation and topographic characteristics.19 In this study,
the hypotheses tested were that the mechanical prop-
erties, measured as flexural and impact strengths, of 2
proprietary polyamide denture base materials would be
different and that exposure to peroxymonosulfate-
based disinfectant would alter their flexural and
impact strengths.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 121 Issue 5
MATERIAL AND METHODS
Dental stone mixed according to the manufacturer’s in-
structions was used to invest the respective denture base
flasks. The mold was created with a ratio of 100 g of
gypsum (Pankaj Enterprises) to 30 mL of water. Metal
dies of appropriate dimensions were invested in the
gypsum to create a mold space for introducing molten
flexible denture material. Specimen dimensions followed
standards set by the International Standards Organiza-
tion20: 64×10×2.5 mm for flexural testing and 80×10×4.0
mm for impact testing. After the gypsum mold had set,
wax sprues were attached to the metal dies. The cope of
the flask was accurately positioned and filled with gyp-
sum under vibration to prevent air bubbles. The wax was
eliminated under boiling water, the flask was opened,
and the metal dies were removed. The gypsum mold was
heated according to the manufacturer instructions, and
the flexible resin material in their respective cartridges
was heated in an electric furnace (Dentsply Sirona). Resin
material was injected into the mold space using a manual
injection unit. The flasks were bench cooled before de-
flasking and cutting sprues with a carborundum disk.
Finishing and polishing were carried out with silicon
carbide disks and a polishing lathe.
Denture base specimens were fabricated according to
the specified guidelines in relation to dimensions. A 2%
(w/v) concentration of disinfectant solution was prepared
by dissolving 40 g of Perform powder in 2 L of distilled
water. A freshly prepared disinfectant solution was used.
Half of the specimens were disinfected for 24 hours in a
controlled environment. Specimens were tested within a
controlled environment at a temperature of 23 ±2 C
while maintaining a relative humidity of 50 ±5% using a
humidifier.
A total of 48 specimens were fabricated. Of these, 24
were immersed in a 2% disinfectant solution for 24 hours
as the intervention group. The remaining 24 specimens
were immersed in distilled water as the control group. In
each group, 12 specimens were tested for flexural
strength and impact strength after conditioning in a
controlled environment. The specimens were placed in a
closed room at a temperature of 23 ±2 C. Relative hu-
midity was maintained at 50 ±5% for a minimum of 40
hours.
The denture base specimens for flexural testing were
64×10×2.5 mm in dimension. Flexural testing was carried
out according to ISO 178: 2000 specifications.20 Support
separation was calculated using a ratio of 16:1 in relation
to the width of the specimen. Thus, with a specimen
width of 2.5 mm, a 40-mm-span length was set. A pre-
load of 0.1 MPa was applied, and the test speed was set
at 1 mm/min. Testing was carried out to 5% deflection as
the test material was flexible. The values of flexural
strength were recorded in MPa.
Sequeira et al
May 2019 845

Table 1. Comparison of baseline flexural and impact strength between Table 2. Comparison of flexural and impact strengths between Perform-
Valplast versus Sunflex groups nonexposed (control) and Perform-exposed (intervention) Valplast
Group Mean ±SD P groups
Flexural strength (MPa) Groups Mean ±SD (MPa) P
Valplast 27.8 ±0.56 <.001 Flexural strength (MPa)
Sunflex 57.4 ±4.09 VN 27.7 ±0.57 .015
Impact strength (kJ/m2) VD 28.6 ±1.37
Valplast 3.4 ±0.98 .001 Impact strength (kJ/m2)
Sunflex 6.0 ±3.11 VN 3.5 ±0.98 <.001

SD, standard deviation.

VD 4.9 ±0.67

SD, standard deviation; VD, Valplast disinfected; VN, Valplast nondisinfected.

The dimension of the specimens for impact testing Table 3. Comparison of flexural and impact strengths between Perform-
was 80×10×4 mm. Impact strength testing was per- nonexposed (control) and Perform-exposed (intervention) Sunflex
formed according to ISO 179-1:2010(E) specifications groups
with a notched Charpy test. This specification describes a Groups Mean ±SD P
method of determining the impact strength of plastics Flexural strength (MPa)
under defined conditions. The specimens were notched SN 57.4 ±4.09 .179
using a motorized notch cutter because it was observed SD 59.0 ±4.08
that unnotched test specimens did not fracture. A 7.5-J Impact strength (kJ/m2)
hammer was used for testing with an impact velocity of SN 6.0 ±3.11 .499
3.807 m/s until complete fracture. The values of impact SD 6.6 ±3.01

strength were recorded in kJ/m2. Flexural and impact SD, standard deviation; SD, Sunflex disinfected; SN, Sunflex nondisinfected.

testing was performed at a room temperature of 23 ±2 C

and relative humidity of 50 ±5%.
The specimens were grouped as follows: group VN
(Valplast control), group VD (Valplast exposed to
Perform), group SN (Sunflex control), and group SD
(Sunflex exposed to Perform). The flexural strength and
impact strength of all groups were measured. Impact
testing resulted in the complete fracture of every spec-
imen. The primary outcome variables included the flex-
ural and impact strength of Valplast and Sunflex.
The independent sample Student t test was per-
formed, and the data were analyzed using a statistical
software program (IBM SPSS Statistics, v20; IBM Corp).
Bonferroni correction was applied (a=.008). As no pre-
vious estimates were available for the primary outcome,
sample size was not estimated, but a post hoc power
calculation was performed.
RESULTS
The mean baseline flexural strength and impact strength
of the Valplast group were 27.8 ±0.57 MPa and 3.5 ±0.98
kJ/m2, respectively. The corresponding values for the
Sunflex group were 57.4 ±4.09 MPa and 6.0 ±3.11 kJ/m2
(Table 1). The difference in the mean flexural strength
(27.8 ±0.56 MPa versus 57.4 ±4.09 MPa; P<.001) and the
mean impact strength (3.5 ±0.98 kJ/m2 versus 6.9 ±3.11
kJ/m2; P=.001) of the Valplast versus the Sunflex group
was statistically significant (Tables 2 and 3). A statistically
significant increase was found in the impact strength
(3.5 ±0.98 kJ/m2 versus 4.9 ±0.67 kJ/m2; P<.001) but not
in the flexural strength of Valplast after exposure to
peroxymonosulfate disinfectant solution for 24 hours
(Tables 2 and 3). Immersion disinfection had no signifi-
cant effect on Sunflex (Table 3). Sunflex had significantly
greater baseline flexural and impact strengths when the 2
control groups were compared (Table 1).
DISCUSSION
This study reveals differences in the mechanical proper-
ties, measured as flexural and impact strengths, of 2
commonly used denture base materials. The effect of
disinfectant exposure on these polyamides was also
different. These findings confirm the hypotheses of the
present study.
One of the chief requirements of any denture base is
adequate mechanical and physical properties. High
strength, hardness, toughness, dimensional stability, and
low density are all favorable qualities for denture base
materials. High impact strength and flexural strength
generate a prosthesis that is durable, tough, and more
resistant to damage. This is of greater relevance when
prostheses are used in high-stress situations.
Immersion disinfection is a critical step in handling
any prosthesis and may alter the mechanical properties of
polyamides such as Valplast but not Sunflex, as revealed
by this study. Dental prostheses brought into a clinic for
repair or adjustments are potential reservoirs of patho-
gens and must be disinfected to prevent disease trans-
mission. Studies on chemical disinfection have used 2%
glutaraldehyde, diluted sodium hypochlorite, and chlo-
rine dioxide among others. Other studies have used a 15-
second scrub with chlorhexidine, followed by 3 minutes

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846
of contact time with chlorine dioxide to disinfect acrylic
resin.13,17 However, studies have mainly addressed sur-
face disinfection, without assessing the absorption of
fluids by the material. Evidence exists that microbial
contamination of acrylic resin prostheses occurs on the
superficial surface as well as within the matrix, thus
necessitating disinfection throughout the thickness of the
material and not solely on its surface.18 Additional
studies of this nature are required to further understand
this phenomenon.
The mechanical properties of conventional poly-
methylmethacrylates deteriorate after immersion disin-
fection.17,18 Comparable studies on nylon denture
materials are limited. Immersion disinfection in Perform
was tested in the present study because the active con-
stituent, potassium peroxymonosulfate, has been re-
ported to be an effective antimicrobial agent.18
Peroxymonosulfate is also the active ingredient in Val-
Clean, a commercially available denture cleanser rec-
ommended for use with Valplast dentures.
Impact strength has an important influence on the life
span of a material and expresses the energy required to
fracture the material under impact force. Reasonable
impact strength would therefore be beneficial for pros-
theses expected to encounter high stress. Flexural
strength is defined as the material’s ability to resist
deformation under load and represents the highest stress
experienced within the material at its moment of rupture.
Both flexural and impact testing are necessary to un-
derstand the physical and mechanical behavior of the
material.
The authors are unaware of a previous study that
has directly compared the baseline flexural and impact
strengths of Valplast and Sunflex. The results of the
present study revealed significantly greater flexural and
impact strengths of the Sunflex material than those of
Valplast. This also indicates the greater flexibility of the
Valplast material, which has relevant clinical implica-
tions. Valplast would be better suited to a situation with
deep bony undercuts as insertion and removal would
be more comfortable and easier for the patient.
The rigidity of a flexible denture base material (Luci-
tone FRS) was reported to increase after immersion
disinfection in Perform.21 However, its flexural yield
strength did not change after disinfection. The present
study found a similar result with Sunflex; no change in
flexural or impact strength was observed after immersion
disinfection. However, Valplast increased in impact
strength after identical disinfection protocols.
The greater flexibility of Valplast would be a disad-
vantage if the prosthesis is to replace extensive hard and/
or soft tissues. In such procedures, the more rigid Sunflex
would have better stability in the oral cavity. Sunflex
would therefore have multiple applications in high-stress
conditions. Individuals who are at high risk of fracturing
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 121 Issue 5
their prosthesis may benefit from this specific denture
base material.
Based on the findings, the disinfection of Valplast
with peroxymonosulfate increased its impact strength
and, in theory, rigidity. Future clinical trials are needed to
assess whether the rigidity is adequate to remain stable
over the denture bearing area and/or implant abutments.
Studies addressing variable immersion exposure time,
repeated exposure, analysis of the material composition,
and the effect of disinfectant exposure on other flexible
denture materials may provide further clinically relevant
insights.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusions were drawn:
1. The flexural and impact strengths of Sunflex were
significantly greater than those of Valplast.
2. Immersion disinfection with peroxymonosulfate had
no significant effect on Sunflex but increased the
impact strength of Valplast.
3. These findings are relevant in selecting the most
appropriate denture base material in dental practice.
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Corresponding author:
Dr Aparna I. Narayan
Associate Dean
Manipal College of Dental Sciences
Department of Prosthodontics and Crown & Bridge
Manipal Academy of Higher Education
Manipal, Karnataka
INDIA
Acknowledgments
The authors thank Konkan Speciality Polyproducts Pvt Ltd for the testing facility,
DentCare Dental Lab Pvt Ltd and Schülke & Mayr Pvt Ltd for materials, and
Dr RP Sequeira for assistance in preparing this manuscript.
Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2018.08.006

Noteworthy Abstracts of the Current Literature

Influence of residual thermal stresses on the edge chipping resistance of PFM and
veneered zirconia structures: Experimental and FEA study

Tanaka CB, Ballester RY, De Souza GM, Zhang Y, Meira JBC

Dent Mater 2019;35:344-55

Objective. Chipping fractures of the veneering porcelain are frequently reported for veneered all-ceramic crowns. In
the present study, the edge chipping test is used to measure the toughness and the edge chipping resistance of
veneered zirconia and porcelain-fused-to-metal (PFM). The aim is to describe an edge chipping method developed
with the use of a universal testing machine and to verify the accuracy of this method to determine the influence of
residual thermal stresses on the chipping fracture resistance of veneering porcelain. A finite element analysis (FEA) was
used to study the residual stress profiles within the veneering porcelain.
Methods. Veneered zirconia and PFM bar specimens were subjected to either a fast or a slow cooling protocol. The
chipping resistances were measured using the edge chipping method. The load was applied in two different directions,
in which the Vickers indenter was placed in the veneering porcelain either parallel or perpendicular to the veneer/
framework interface. The mean edge chipping resistance (ReA) and fracture toughness (KC) values were analysed. ReA
was calculated by dividing the critical force to cause the chip by the edge distance. KC was given by a fracture analysis
that correlates the critical chipping load (FC) regarding edge distance (d) and material toughness via KC=FC/(bd1.5).
Results. The ReA revealed similar values (p>0.005) of chipping resistance for loads applied in the parallel direction
regardless of framework material and cooling protocol. For loads applied in the perpendicular direction to the
veneer/framework interface, the most chip resistant materials were slow cooled veneered zirconia (251.0N/mm) and
the PFM fast cooled (190.1N/mm). KC values are similar to that for monolithic porcelain (0.9MPa.√m), with slightly
higher values (1.2MPa.√m) for thermally stressed PFM fast cooled and veneered zirconia slow cooled groups.
Significance. The developed and reported edge chipping method allows for the precise alignment of the indenter in
any predetermined distance from the edge. The edge chipping method could be useful in determining the different
states of residual thermal stresses on the veneering porcelain.
Reprinted with permission of The Academy of Dental Materials.

Sequeira et al THE JOURNAL OF PROSTHETIC DENTISTRY